Baltimore City’s Preventing Substance Exposed Pregnancies Collaborative

B’more PSEP – Year in Review

• Accomplishments– Public/Private Partnerships – Needs Assessment and Strategic Plan Developed

• Challenges• Impact• Next Steps• Lessons Learned

Accomplishments- Partnerships• State institutions

– Department of Health and Mental Hygiene – Title X• City institutions

– Baltimore Substance Abuse Systems (bSAS)– Adolescent and Reproductive Heath (ARH)– State and Local Office of Women, Infants and Children (WIC)– Division of Sexually Transmitted Disease

• Academic and Medical Institutions – University of Maryland– Johns Hopkins University

• Health care organizations– Planned Parenthood– Substance abuse treatment organizations

• Consultants– Mosaic Consultants– Johns Hopkins University Center for Communication Programs

Accomplishments - Needs Assessment

• Literature review showed limited research addressing family planning for drug users or individuals in drug treatment– Several studies addressed intendedness of pregnancy

among actively using women– Several studies addressed contraceptive use rates among

women in drug treatment– One study included focus groups in treatment centers

about perceptions of family planning /contraception– One study compared women’s choice of contraception

during pregnancy and method received post-partum

Accomplishments - Needs Assessment Site mapping shows heavy emphasis on treatment versus prevention

• 42 bSAS-funded organizations

• 48 non-bSAS-funded treatment centers

• 6 Title X clinics across city

Accomplishments – Needs Assessment

>47 yo29%

41-46 yo24%

35-40 yo16%

29-34 yo11%

22-38 yo11%

17-22 yo5%

11-16 yo3%

Data analysis showed that of the 5,209 women enrolled in treatment in 2011, 71% were between the ages of 11 and 46 years. BSAS

The percentage of women in the 15-29 age group has been increasing among Baltimore City Female Residents of Reproductive Age Admitted to bSAS-Funded

Treatment Programs

Note: numbers are not unique clients; Source: SMART database

Age FY 2009, n=4204 FY 2010, n=3886 FY 2011, n=3764

11-14 0.52% 0.51% 1.12%

15-19 3.24% 3.65% 5.69%

20-24 7.14% 9.14% 9.56%

25-29 10.97% 12.09% 13.97%

30-34 12.63% 11.32% 13.63%

35-39 22.95% 20.07% 17.06%

40-46 42.55% 43.21% 38.97%

Total 100.00% 100.00% 100.00%

Active Reproductive

life years

Accomplishments - Needs Assessment

Accomplishments – Needs Assessment Prevention Medicine Resident completed survey of BSAS-funded treatment organizations

• Completed by 27 of 41 BSAS-funded treatment organizations that see women – ASAM Levels I,II,III represented

• Content covered– Treatment organization logistics– Family Planning/contraception

• Is it asked about on intake• Is counseling provided • Are referrals provided• Are methods provided on-site

• Barriers to providing any of the aforementioned services (counseling, provision of methods, etc)

• Interest in specific types of FP/contraception resources

Accomplishments - Needs Assessment

• Results– Most treatment centers are not asking about

contraception at intake– Most treatment centers are not providing any

formal family planning education– Most treatment centers are not providing

contraceptive services onsite (aside from providing free condoms)

– Most treatment centers are interested in utilizing family planning resources

Accomplishments – Needs Assessment

• Recommendations – No one-size fits all method, select sites strategically

• Treatment centers vary in available staff and volume of clients served (some have MD, NP, PA, RN available and others do not)

• Programming for intensive outpatient programs (9 hours per week) may be different from programming for clients in residential programs

• Some sites have programs specifically for women with young children, others serve much older populations

– Minimize paper work– Don’t forget about incentives– Use existing supportive staffing such as the HPAs from bSAS for

future work

Challenges

• Limited data on the problem of substance use/abuse in the city

• Limited literature on effectiveness of including family planning counseling and services in drug treatment centers

• Major agency changes – integration of Mental Health and Substance treatment services

• Staff work in silos in and across public agencies

Impact

– Identifying and getting the right people at the table to tell the story

– Discovering the major gap in and desire for family planning counseling and treatment at drug treatment centers

– Having major city partners self-identify for training in SBIRT

– Developing a joint strategic plan that we can now market to funders

Next Steps• We see the collaborative continuing and have

identified at least one potential funding source—OSI• We will conduct qualitative research to identify best

methodology and messaging for implementing SBIRT in WIC and FP clinics and for introducing FP in treatment centers

• We are exploring best practices in smoking cessation and the possibility of the use of air cleaners as a more comprehensive strategy to improve indoor air quality

Lessons Learned

• All partners linked in any way to the work must be invited to the table during all stages of the planning process

• Ultimately, a collaborative need funding to maintain interest